Intriguing presentation of abdominal pregnancy: Four years of sterile liquefactive necrosis in a background retroviral disease

Abstract

Abdominal Pregnancy often constitutesa life-threatening obstetric emergency. The associated maternal morbidity and mortality are very high especially in advanced cases. We present an intriguing case of long lasting (four years duration) of advanced abdominal pregnancy in a 32-year- old retroviral disease positive G2P1 +0 woman with no living child. Following initial evaluations and diagnosis at different peripheral hospitals, she declined consent for surgery despite counselling because of erroneous believes that her problem was ‘spiritual’. However, her illness persisted and she eventually presented at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu where she finally consented to exploratory laparotomy. An organized 26weeks size thick-walled mass, containing necrotic fetal parts with easily identifiable skull and long bones was delivered. There was also an adjourning sterile abscess collection that was evacuated. Her post-operative recovery was uneventful. The delay in carrying out exploratory laparotomy on this women caused by her initial refusal to give consent brings up controversies surrounding ethical principle of personal autonomy which were also highlighted in this case report.

Keywords

• advanced abdominal pregnancy
• sterile fetal liquefactive necrosis
• personal autonomy controversy
• enugu